Health Assessment Exam 3

Front 1

Cranial Nerve I (1)

Back 1

Olfactory
Function: Smell

Front 2

Cranial Nerve II (2)

Back 2

Optic
Function: Vision

Front 3

Cranial Nerve III (3)

Back 3

Oculomotor
Function: Motor Function of extraoccular movement, opening of eyelids
Parasympathetic functions of pupil constriction and lens shape.

Front 4

Cranial Nerve IV (4)

Back 4

Trochelear
Motor Function: Down and inward movement of the eye

Front 5

Cranial Nerve V (5)

Back 5

Trigeminal
Motor Function: Muscles of mastication (chewing)
Sensory Function:sensation of face and scalp, cornea, mucous membranes of mouth and nose

Front 6

Cranial Nerve VI (6)

Back 6

Abducens
Motor Function: Lateral movement of the eye

Front 7

Cranial Nerve VII (7)

Back 7

Facial
Motor Function: facial muscles, close eye, labial speech, close mouth
Sensory Function: Taste (sweet, salty, sour, bitter) on the anterior 2/3 of the tongue
Parasympathetic function-saliva and tear secretion

Front 8

Cranial Nerve VIII (8)

Back 8

Acoustic
Sensory Function: Hearing and equilibrium

Front 9

Cranial Nerve IX (9)

Back 9

Glossopharyngeal
Motor Function-pharynx including swallowing and phonation
Sensory Function- taste on posterior one-third of the tongue, pharynx (gag reflex)

Front 10

Cranial Nerve X (10)

Back 10

Vagus
Motor Function: Pharynx and Larynx (talking and swallowing)
Sensory Function: General sensation from carotid body, carotid sinus, pharynx , viscera
Parasympathetic function: carotid reflex

Front 11

Cranial Nerve XI (11)

Back 11

Spinal
Motor Function: Movement of the trapezius and sternomastoid muscles

Front 12

Cranial Nerve XII (12)

Back 12

Hypoglossal
Motor Function: Movement of the tongue

Front 13

objective vertigo

Back 13

feels like the room is spinning

Front 14

subjective vertigo

Back 14

is present when the patient experiences the sensation of turning or moving around in space. Objective vertigo is the sensation of objects moving around the patient.

Front 15

glasgow coma scale

Back 15

15 = no coma, 7 coma, 3 profound coma. Eye opening, verbal response, motor response

Front 16

nystagmus

Back 16

back-and-forth oscillation of the eyes; occurs with disease of the vestibular system, cerebellum, or brainstem

Front 17

Aphasia

Back 17

the loss of the ability to speak, write, and/or comprehend the written or spoken word; usually caused by damage to left hemisphere

Front 18

coma

Back 18

state of profound unconsciousness from which person cannot be aroused

Front 19

decerebrate rigidity

Back 19

Upper extremities- stiffly extended, adducted, internal rotation,palms pronated. Lower extremities-stiffly extended, plantar flexion; teeth clenched;hyperextended back;indicates lesion in the brain stem at midbrain or upper pons

Front 20

decorticate rigidity

Back 20

Decorticate rigidity occurs when there are lesions of the cerebral hemispheres. Damage to the brain occurs above the brainstem and cerebellum (i.e., above the tentorium). There is upper extremity flexion (arms in fetal position) and lower extremity extension.

Front 21

dysphasia

Back 21

impairment in speech consisting of lack of coordination and inability to arrange words in their proper order

Front 22

Paralysis

Back 22

Loss of motor function due to a lesion in the neurologic or muscular system or loss of sensory innervation

Front 23

Paresthesia

Back 23

abnormal sensation (such as burning, prickling, or tingling sensation, often in the extremities; may be caused by nerve damage or peripheral neuropathy

Front 24

Tic

Back 24

repetitive twitching of a muscle at inappropriate times

Front 25

deep tendon reflex

Back 25

Reveals the intactness of the reflex arc at specific spinal levels as well as the normal override on the reflex of the higher cortical levels.
Consists of: Patella, Biceps, Triceps, Brachioradialis, Quadriceps, Achilles Reflexes

Front 26

Superficial Reflexes

Back 26

- initiated by gentle cutaneous stimulation
Ex) plantar reflex is initiated by stimulating the lateral aspect of the sole of the foot
- response is downward flexion of toes
- indirectly test for proper corticospinal tract functioning
- Babinski's sign: abnormal plantar reflex indicates corticospinal damage where the great toe dorsiflexes and the small toes fan laterally

Front 27

Testing persons gait/balance

Back 27

Observe persons gait as they walk 10 to 20 feet, turns and returns to the starting point
Normal Finding:The person moves with a sense of freedom; The gait is smooth, rhythmic and effortless, the opposing arm swing is coordinated and the turns are smooth.
Step Length about 15inches from heel to heel.

Front 28

Balance Test Abnormal Findings

Back 28

Stiff, immobile posture. Staggering or reeling. Wide base of support.
Lack of arm swing or rigid arms.
Unequal rhythm of steps
Slapping of foot.
Scraping of toe of shoe.

Front 29

Tandem walking

Back 29

Assess balance by asking person to walk a straight line in a heel-to-toe fashion.
This decreases the base of support and will accentuate any problem with coordination.

Front 30

Romberg Test

Back 30

Ask the person to stand up with feet together and arms at the sides.
Once in a stable position, wait 20 seconds.
Normal Finding: a person can maintain posture and balance even with visual orienting information blocked, although slight swaying may occur

Front 31

Knee Bend/Hop in Place

Back 31

Demonstrates normal position sense, muscle strength and cerebellar function

Front 32

Positive Romberg Sign

Back 32

Loss of balance that occurs when closing the eyes.
Occurs with cerebellar ataxia (multiple sclerosis, alcohol intoxication) loss of proprioception and vestibular function

Front 33

Rapid Alternating Movements

Back 33

Assess coordination by asking person to pat the knees with both hands, lift up, turn hands over and pat knees with the backs of the hands. Then ask them to do it faster.
Normal Finding: Done with a equal turning and quick rhythmic pace

Front 34

Summation

Back 34

When frequent consecutive stimuli are perceived as one strong stimulus.
Avoid this by letting 2 seconds elapse between each stimulus.

Front 35

1=Hypoalgesia
2=Hyperalgesia
3=Analgesia

Back 35

1=decreased pain sensation
2=increased pain sensation
3=absent paint sensation

Front 36

1=Hypoesthesia
2=Anesthesia
3=Hyperesthesia

Back 36

1=decreased touch sensation
2=absent touch sensation
3=increased touch sensation

Front 37

Peripheral Neuropathy

Back 37

Abnormal Finding for Vibration Test
Is worse at the feet and gradually improves as you move up the leg.

Front 38

Loss of vibration sense

Back 38

Occurs with peripheral neuropathy like
Diabetes, and alcoholism
*Often first sensation lost

Front 39

Proprioception

Back 39

Without looking you know where your body parts are in relation to space and each other, vibration and finely localized touch.

Front 40

Stereognosis

Back 40

Test the persons ability to recognize objects by feeling their forms, sizes and weights.
Example: With person's eyes closed place a familiar object like a paper clip, key, coin, cottonball or pencil in their hands and ask them to identify it.
Normal Finding: Person will explore it with fingers and correctly name it.
Assess with a different object in each hand.

Front 41

Kinesthesia

Back 41

Test the persons ability to perceive passive movements of the extremities. (Positions) Move a finger on the big toe up and won and ask the person to tell you which way it moved.
Make sure the persons's eyes are closed and that they understand the test.

Front 42

Graphesthesia

Back 42

Is the ability to "read" a number by having it traced on the skin. With the person's eyes closed, use a blunt instrument to trace a single digit number or a letter on the palm.
Ask the person to tell you what it is.

This is a Good measure of sensory loss if the person cannot make the hand movements needed for stereognosis.

Front 43

Deep tendon reflex

Back 43

Reveals the intactness of the reflex arc at specific spinal levels as well as the normal override on the reflex of the higher cortical levels.
Consists of: Biceps, Triceps, Brachioradialis, Quadriceps, Achilles Reflexes

Front 44

Testing the Deep tendon reflex

Back 44

The limb should be relaxed and the muscle partially stretched. Stimulate the reflex by directing a short, snappy blow of the hammer onto the muscles insertion tendon.
Example: Knee Jerk or Patellar Area

Front 45

Visceral Reflex

Back 45

Example: Pupillary response to light and accommodation

Front 46

Babinskis sign

Back 46

Pathologic Reflex
Abnormal response is dorsiflexion of the big toge and fanning of all toes.
"Upgoing toes"
Occurs with upper motor neuron disease of the corticospinal tract.

Front 47

Decrease in cerebral blood flow

Back 47

Occurs with aging
Can cause dizziness and loss of balance with position change. These people need to be taught to get up slowly to prevent falls.

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Front 48

CHILD'S EARS

Back 48

o Ear is posteriorly rotated and low set—later it ascends to its normal placement around eye level
 If maternal rubella infection occurs during the first trimester, it can damage the organ of Corti and impair hearing
o Eustachian tube is shorter and wider and its position is more horizontal than the adult's—easier for infections from nasopharynx
o Lumen is surrounded by lymphoid tissue—increase during childhood—lumen is easily occluded—greater risk for middle ear infections than adult
o Ear canal is short and has a slope opposite to that of the adults

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Front 49

ADULT'S EARS

Back 49

Otosclerosis-common cause of conductive hearing loss between 20-40 yrs—gradual hardening that causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound and causing progressive deafness

Front 50

ASSESSING HEARING

Back 50

Ask the person directly if he/she thinks theres a hearing difficulty.
o Yes? Perform/refer audiometric testing -gives precise quantitative measure of hearing by assessing the person's ability to hear sounds of varying frequency
o No? use whispered voice test—a whisper is a high freq sound that is used to detect high-tone loss
o Tuning fork test- measure hearing by air conduction (AC) or by bone conduction (BC) in which the sound vibrates through the cranial bones to the inner ear.—not use for general screening

Front 51

PATHWAYS OF HEARING

Back 51

the normal pathway of hearing is air conduction (AC) -it is the most efficient. An alt route of hearing is by bone conduction (BC). Here, the bones of the skull vibrate. These vibrations are transmitted directly to the inner ear and to cranial nerve VIII

Front 52

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Equilibrium

Back 52

the labyrinth in the inner ear is constantly feeds info to your brain about ur body's position in space
o Determine verticality&depth -register angle of head relation to gravity
o If inflamed->wrong info will be sent to the brain->stagering gait, strong, spinning, whirling sensation=vertigo

Front 53

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Using the Otoscope

Back 53

• Choose largest speculum
• Tilt person's head away frm you toward the opposite shoulder—brings the obliquely sloping eardrum into view
• Pull pinna back and up=adult&older children; pull pinna back and down=infant&younger children
• Don't release traction on the ear until you have finished the examination and the otoscope is removed
• Have the back of ur hand braced along the person's cheek to stead the ostoscope->prevent forceful insertion and hands will act as a protecting level if the person suddenly moves the head
• Avoid touching the inner "bony" section of the canal wall, which is covered by a thin epithelial layer and is sensitive to pain
• If you cannot see anything but canal wall-reposition person's head, apply more traction on the pinna, re-angle the otoscope to look forward toward the person's nose
• Perform otoscope before testing hearing—ear canals w/ impacted cerumen give the erroneous impression of pathologic hearing loss

Front 54

Presbyopia

Back 54

accommodation with aging , when you have to move content further from eyes to read

Front 55

Confrontation test

Back 55

tests peripheral vision loss

Front 56

Corneal light reflex

Back 56

looks for parallel alignment and symmetry

Front 57

Cover test

Back 57

checks for deviation and eye muscle weakness

Front 58

strabismus

Back 58

eye misalignment

Front 59

phoria

Back 59

weakness of eye muscles

Front 60

extra occular

Back 60

structures outside of eye

Front 61

Lacrimal apparatus

Back 61

check for inflammation, redness, drainage

Front 62

PERRLA

Back 62

Pupils Equal Round Reactive to light & accommodation

Front 63

old people

Back 63

vision diminished with age

diminished peripheral vision

dry eyes (side effects of medications?)

Arcus senilis-from accumulation of fats (no treatment needed)

Front 64

Exopthalmos

Back 64

forward displacement of eye ball ( graves)

Front 65

Conjuctivitis

Back 65

pink eye

Front 66

periorbital edema

Back 66

serious sign of renal failure, allergy, CHF,

Front 67

Cataract

Back 67

opacity

older adult

congenital

Front 68

Glaucoma

Back 68

increasing intraocular pressure

loss of peripheral vision

Front 69

Macular degeneration

Back 69

loss of central vision

old people

Front 70

scotoma

Back 70

blind spot

Front 71

Seeing halos around objects or lights

Back 71

can indication acute narrow angle glaucoma

Front 72

diplopia

Back 72

double vision

Front 73

Otorrhea

Back 73

ear discharge

Maybe due to perforated tympanic membrane

purulent from infection

Front 74

Gradual hearing loss

aging

Back 74

Presbycusis

Front 75

Tinnitus

Back 75

Ringing, crackling, or buzzing in ears

maybe side effect of OTOTOXIC drugs aspirin, Lasix and antibiotics

Front 76

Cerumen

Back 76

earwax

formation is genetic

Front 77

Adult 3 and up

Back 77

pull ear UP and back

Front 78

Child 2 and under

Back 78

pull ear down and back

Front 79

Whisper voice test

Back 79

Mask one ear at a time and stand 1-2 feet from pt. whisper 2 syllable word. Test each ear

Front 80

If pt. admits hearing difficulty

Back 80

refer for audiometric hearing tests

Front 81

Conductive hearing loss

Back 81

defect in transmission of sound from external to middle ear. Air conduction is impeded

Front 82

Sensorineural hearing loss

Back 82

defect in inner ear that leads to distortion of sound and misinterpretation of speech

Front 83

Infant considerations when examining the ears

Back 83

Do last because its most distressing for infant

Front 84

Older adult considerations when examining the ears

Back 84

High tone hearing loss with presbycusis, common with cerumen impaction

Front 85

Otitis media

Back 85

middle ear infections common in children due to more horizontal position of Eustachian tubes, can cause speech problems due to unable to hear correctly

Front 86

Epistaxis

Back 86

Nosebleed

Sit up and tilt head forward pinching nose and hold 5-15 minutes

Front 87

Bleeding gums

Back 87

Pt. such as pregnant woman , vit c deficit , poor hygiene and puberty

Front 88

Dysphagia

Back 88

trouble or hurts to swallow

Due to pharyngitis, GERD, stroke cancer of throat

Front 89

Xerostomia

Back 89

decreased salvia

Front 90

Gingival hyperplasia

Back 90

Hormonal imbalance that triggers inflammation and Painless enlargement of gums sometimes overreaching the teeth.

pregnant woman can get this easier

Front 91

Detecting early dehydration in elderly

Back 91

dry mucous membranes, mouth breathing, tongue furrows, acute confusion and area where gum and cheek membranes meet dry

Front 92

oropharynx

Back 92

tonsils

Front 93

Leukoplakia

Back 93

Precancerous that doesn't scrape off

White lesions

Front 94

Candidiasis (trush)

Back 94

white patches that are yeast infections that scrape off